|
TIBIAL INSERT PFC SZ 4 10.0MM
|
Facility
|
OP
|
$7,610.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.38 |
| Max. Negotiated Rate |
$7,306.20 |
| Rate for Payer: Aetna Commercial |
$5,860.19
|
| Rate for Payer: Anthem Medicaid |
$2,617.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,936.29
|
| Rate for Payer: Cash Price |
$3,805.31
|
| Rate for Payer: Cigna Commercial |
$6,316.82
|
| Rate for Payer: First Health Commercial |
$7,230.10
|
| Rate for Payer: Humana Commercial |
$6,469.04
|
| Rate for Payer: Humana KY Medicaid |
$2,617.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,643.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,240.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,616.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,283.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,669.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,697.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,707.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,522.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,359.30
|
| Rate for Payer: PHCS Commercial |
$7,306.20
|
| Rate for Payer: United Healthcare All Payer |
$6,697.35
|
|
|
TIBIAL INSERT PFC SZ 4 12.5MM
|
Facility
|
IP
|
$7,610.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.38 |
| Max. Negotiated Rate |
$7,306.20 |
| Rate for Payer: Aetna Commercial |
$5,860.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,936.29
|
| Rate for Payer: Cash Price |
$3,805.31
|
| Rate for Payer: Cigna Commercial |
$6,316.82
|
| Rate for Payer: First Health Commercial |
$7,230.10
|
| Rate for Payer: Humana Commercial |
$6,469.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,240.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,616.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,283.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,697.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,707.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,522.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,359.30
|
| Rate for Payer: PHCS Commercial |
$7,306.20
|
| Rate for Payer: United Healthcare All Payer |
$6,697.35
|
|
|
TIBIAL INSERT PFC SZ 4 12.5MM
|
Facility
|
OP
|
$7,610.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.38 |
| Max. Negotiated Rate |
$7,306.20 |
| Rate for Payer: Aetna Commercial |
$5,860.19
|
| Rate for Payer: Anthem Medicaid |
$2,617.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,936.29
|
| Rate for Payer: Cash Price |
$3,805.31
|
| Rate for Payer: Cigna Commercial |
$6,316.82
|
| Rate for Payer: First Health Commercial |
$7,230.10
|
| Rate for Payer: Humana Commercial |
$6,469.04
|
| Rate for Payer: Humana KY Medicaid |
$2,617.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,643.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,240.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,616.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,283.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,669.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,697.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,707.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,522.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,359.30
|
| Rate for Payer: PHCS Commercial |
$7,306.20
|
| Rate for Payer: United Healthcare All Payer |
$6,697.35
|
|
|
TIBIAL INSERT PFC SZ 4 15.0MM
|
Facility
|
OP
|
$7,610.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.38 |
| Max. Negotiated Rate |
$7,306.20 |
| Rate for Payer: Aetna Commercial |
$5,860.19
|
| Rate for Payer: Anthem Medicaid |
$2,617.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,936.29
|
| Rate for Payer: Cash Price |
$3,805.31
|
| Rate for Payer: Cigna Commercial |
$6,316.82
|
| Rate for Payer: First Health Commercial |
$7,230.10
|
| Rate for Payer: Humana Commercial |
$6,469.04
|
| Rate for Payer: Humana KY Medicaid |
$2,617.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,643.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,240.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,616.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,283.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,669.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,697.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,707.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,522.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,359.30
|
| Rate for Payer: PHCS Commercial |
$7,306.20
|
| Rate for Payer: United Healthcare All Payer |
$6,697.35
|
|
|
TIBIAL INSERT PFC SZ 4 15.0MM
|
Facility
|
IP
|
$7,610.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.38 |
| Max. Negotiated Rate |
$7,306.20 |
| Rate for Payer: Aetna Commercial |
$5,860.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,936.29
|
| Rate for Payer: Cash Price |
$3,805.31
|
| Rate for Payer: Cigna Commercial |
$6,316.82
|
| Rate for Payer: First Health Commercial |
$7,230.10
|
| Rate for Payer: Humana Commercial |
$6,469.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,240.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,616.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,283.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,697.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,707.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,522.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,359.30
|
| Rate for Payer: PHCS Commercial |
$7,306.20
|
| Rate for Payer: United Healthcare All Payer |
$6,697.35
|
|
|
TIBIAL INSERT PFC SZ 4 17.5MM
|
Facility
|
IP
|
$7,338.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$953.98 |
| Max. Negotiated Rate |
$7,044.81 |
| Rate for Payer: Aetna Commercial |
$5,650.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,723.91
|
| Rate for Payer: Cash Price |
$3,669.17
|
| Rate for Payer: Cigna Commercial |
$6,090.82
|
| Rate for Payer: First Health Commercial |
$6,971.42
|
| Rate for Payer: Humana Commercial |
$6,237.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,017.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,415.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,201.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,457.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,503.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,467.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$953.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,274.89
|
| Rate for Payer: PHCS Commercial |
$7,044.81
|
| Rate for Payer: United Healthcare All Payer |
$6,457.74
|
|
|
TIBIAL INSERT PFC SZ 4 17.5MM
|
Facility
|
OP
|
$7,338.34
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$953.98 |
| Max. Negotiated Rate |
$7,044.81 |
| Rate for Payer: Aetna Commercial |
$5,650.52
|
| Rate for Payer: Anthem Medicaid |
$2,523.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,723.91
|
| Rate for Payer: Cash Price |
$3,669.17
|
| Rate for Payer: Cigna Commercial |
$6,090.82
|
| Rate for Payer: First Health Commercial |
$6,971.42
|
| Rate for Payer: Humana Commercial |
$6,237.59
|
| Rate for Payer: Humana KY Medicaid |
$2,523.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,549.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,017.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,415.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,201.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,574.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,457.74
|
| Rate for Payer: Ohio Health Group HMO |
$5,503.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,467.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$953.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,274.89
|
| Rate for Payer: PHCS Commercial |
$7,044.81
|
| Rate for Payer: United Healthcare All Payer |
$6,457.74
|
|
|
TIBIAL INSERT PFC SZ 5 10.0MM
|
Facility
|
OP
|
$15,007.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.94 |
| Max. Negotiated Rate |
$14,406.91 |
| Rate for Payer: Aetna Commercial |
$11,555.54
|
| Rate for Payer: Anthem Medicaid |
$5,160.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,705.62
|
| Rate for Payer: Cash Price |
$7,503.60
|
| Rate for Payer: Cigna Commercial |
$12,455.98
|
| Rate for Payer: First Health Commercial |
$14,256.84
|
| Rate for Payer: Humana Commercial |
$12,756.12
|
| Rate for Payer: Humana KY Medicaid |
$5,160.98
|
| Rate for Payer: Kentucky WC Medicaid |
$5,213.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,305.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,075.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,502.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,264.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,206.34
|
| Rate for Payer: Ohio Health Group HMO |
$11,255.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,001.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,652.23
|
| Rate for Payer: PHCS Commercial |
$14,406.91
|
| Rate for Payer: United Healthcare All Payer |
$13,206.34
|
|
|
TIBIAL INSERT PFC SZ 5 10.0MM
|
Facility
|
IP
|
$15,007.20
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,950.94 |
| Max. Negotiated Rate |
$14,406.91 |
| Rate for Payer: Aetna Commercial |
$11,555.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,705.62
|
| Rate for Payer: Cash Price |
$7,503.60
|
| Rate for Payer: Cigna Commercial |
$12,455.98
|
| Rate for Payer: First Health Commercial |
$14,256.84
|
| Rate for Payer: Humana Commercial |
$12,756.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,305.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,075.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,502.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,206.34
|
| Rate for Payer: Ohio Health Group HMO |
$11,255.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,001.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,950.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,652.23
|
| Rate for Payer: PHCS Commercial |
$14,406.91
|
| Rate for Payer: United Healthcare All Payer |
$13,206.34
|
|
|
TIBIAL INSERT PFC SZ 5 12.5MM
|
Facility
|
IP
|
$7,610.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.38 |
| Max. Negotiated Rate |
$7,306.20 |
| Rate for Payer: Aetna Commercial |
$5,860.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,936.29
|
| Rate for Payer: Cash Price |
$3,805.31
|
| Rate for Payer: Cigna Commercial |
$6,316.82
|
| Rate for Payer: First Health Commercial |
$7,230.10
|
| Rate for Payer: Humana Commercial |
$6,469.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,240.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,616.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,283.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,697.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,707.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,522.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,359.30
|
| Rate for Payer: PHCS Commercial |
$7,306.20
|
| Rate for Payer: United Healthcare All Payer |
$6,697.35
|
|
|
TIBIAL INSERT PFC SZ 5 12.5MM
|
Facility
|
OP
|
$7,610.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.38 |
| Max. Negotiated Rate |
$7,306.20 |
| Rate for Payer: Aetna Commercial |
$5,860.19
|
| Rate for Payer: Anthem Medicaid |
$2,617.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,936.29
|
| Rate for Payer: Cash Price |
$3,805.31
|
| Rate for Payer: Cigna Commercial |
$6,316.82
|
| Rate for Payer: First Health Commercial |
$7,230.10
|
| Rate for Payer: Humana Commercial |
$6,469.04
|
| Rate for Payer: Humana KY Medicaid |
$2,617.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,643.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,240.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,616.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,283.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,669.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,697.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,707.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,522.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,359.30
|
| Rate for Payer: PHCS Commercial |
$7,306.20
|
| Rate for Payer: United Healthcare All Payer |
$6,697.35
|
|
|
TIBIAL INSERT PFC SZ 5 15.0MM
|
Facility
|
OP
|
$7,610.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.38 |
| Max. Negotiated Rate |
$7,306.20 |
| Rate for Payer: Aetna Commercial |
$5,860.19
|
| Rate for Payer: Anthem Medicaid |
$2,617.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,936.29
|
| Rate for Payer: Cash Price |
$3,805.31
|
| Rate for Payer: Cigna Commercial |
$6,316.82
|
| Rate for Payer: First Health Commercial |
$7,230.10
|
| Rate for Payer: Humana Commercial |
$6,469.04
|
| Rate for Payer: Humana KY Medicaid |
$2,617.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,643.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,240.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,616.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,283.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,669.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,697.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,707.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,522.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,359.30
|
| Rate for Payer: PHCS Commercial |
$7,306.20
|
| Rate for Payer: United Healthcare All Payer |
$6,697.35
|
|
|
TIBIAL INSERT PFC SZ 5 15.0MM
|
Facility
|
IP
|
$7,610.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.38 |
| Max. Negotiated Rate |
$7,306.20 |
| Rate for Payer: Aetna Commercial |
$5,860.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,936.29
|
| Rate for Payer: Cash Price |
$3,805.31
|
| Rate for Payer: Cigna Commercial |
$6,316.82
|
| Rate for Payer: First Health Commercial |
$7,230.10
|
| Rate for Payer: Humana Commercial |
$6,469.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,240.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,616.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,283.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,697.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,707.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,522.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,359.30
|
| Rate for Payer: PHCS Commercial |
$7,306.20
|
| Rate for Payer: United Healthcare All Payer |
$6,697.35
|
|
|
TIBIAL INSERT PFC SZ 5 17.5MM
|
Facility
|
IP
|
$4,770.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.15 |
| Max. Negotiated Rate |
$4,579.58 |
| Rate for Payer: Aetna Commercial |
$3,673.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,720.91
|
| Rate for Payer: Cash Price |
$2,385.20
|
| Rate for Payer: Cigna Commercial |
$3,959.43
|
| Rate for Payer: First Health Commercial |
$4,531.88
|
| Rate for Payer: Humana Commercial |
$4,054.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,911.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,520.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,431.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,197.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,577.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$954.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,478.82
|
| Rate for Payer: PHCS Commercial |
$4,579.58
|
| Rate for Payer: United Healthcare All Payer |
$4,197.95
|
|
|
TIBIAL INSERT PFC SZ 5 17.5MM
|
Facility
|
OP
|
$4,770.40
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.15 |
| Max. Negotiated Rate |
$4,579.58 |
| Rate for Payer: Aetna Commercial |
$3,673.21
|
| Rate for Payer: Anthem Medicaid |
$1,640.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,720.91
|
| Rate for Payer: Cash Price |
$2,385.20
|
| Rate for Payer: Cigna Commercial |
$3,959.43
|
| Rate for Payer: First Health Commercial |
$4,531.88
|
| Rate for Payer: Humana Commercial |
$4,054.84
|
| Rate for Payer: Humana KY Medicaid |
$1,640.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,657.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,911.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,520.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,431.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,673.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,197.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,577.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$954.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,478.82
|
| Rate for Payer: PHCS Commercial |
$4,579.58
|
| Rate for Payer: United Healthcare All Payer |
$4,197.95
|
|
|
TIBIAL INSERT PFC SZ 6 10.0MM
|
Facility
|
IP
|
$7,610.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.38 |
| Max. Negotiated Rate |
$7,306.20 |
| Rate for Payer: Aetna Commercial |
$5,860.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,936.29
|
| Rate for Payer: Cash Price |
$3,805.31
|
| Rate for Payer: Cigna Commercial |
$6,316.82
|
| Rate for Payer: First Health Commercial |
$7,230.10
|
| Rate for Payer: Humana Commercial |
$6,469.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,240.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,616.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,283.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,697.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,707.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,522.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,359.30
|
| Rate for Payer: PHCS Commercial |
$7,306.20
|
| Rate for Payer: United Healthcare All Payer |
$6,697.35
|
|
|
TIBIAL INSERT PFC SZ 6 10.0MM
|
Facility
|
OP
|
$7,610.63
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.38 |
| Max. Negotiated Rate |
$7,306.20 |
| Rate for Payer: Aetna Commercial |
$5,860.19
|
| Rate for Payer: Anthem Medicaid |
$2,617.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,936.29
|
| Rate for Payer: Cash Price |
$3,805.31
|
| Rate for Payer: Cigna Commercial |
$6,316.82
|
| Rate for Payer: First Health Commercial |
$7,230.10
|
| Rate for Payer: Humana Commercial |
$6,469.04
|
| Rate for Payer: Humana KY Medicaid |
$2,617.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,643.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,240.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,616.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,283.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,669.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,697.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,707.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,522.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,359.30
|
| Rate for Payer: PHCS Commercial |
$7,306.20
|
| Rate for Payer: United Healthcare All Payer |
$6,697.35
|
|
|
TIBIAL INSERT PFC SZ 6 12.5MM
|
Facility
|
IP
|
$7,081.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.59 |
| Max. Negotiated Rate |
$6,798.19 |
| Rate for Payer: Aetna Commercial |
$5,452.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,523.53
|
| Rate for Payer: Cash Price |
$3,540.72
|
| Rate for Payer: Cigna Commercial |
$5,877.60
|
| Rate for Payer: First Health Commercial |
$6,727.38
|
| Rate for Payer: Humana Commercial |
$6,019.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,806.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,226.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,124.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,231.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,311.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$920.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,195.25
|
| Rate for Payer: PHCS Commercial |
$6,798.19
|
| Rate for Payer: United Healthcare All Payer |
$6,231.68
|
|
|
TIBIAL INSERT PFC SZ 6 12.5MM
|
Facility
|
OP
|
$7,081.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.59 |
| Max. Negotiated Rate |
$6,798.19 |
| Rate for Payer: Aetna Commercial |
$5,452.72
|
| Rate for Payer: Anthem Medicaid |
$2,435.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,523.53
|
| Rate for Payer: Cash Price |
$3,540.72
|
| Rate for Payer: Cigna Commercial |
$5,877.60
|
| Rate for Payer: First Health Commercial |
$6,727.38
|
| Rate for Payer: Humana Commercial |
$6,019.23
|
| Rate for Payer: Humana KY Medicaid |
$2,435.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,460.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,806.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,226.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,124.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,484.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,231.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,311.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$920.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,195.25
|
| Rate for Payer: PHCS Commercial |
$6,798.19
|
| Rate for Payer: United Healthcare All Payer |
$6,231.68
|
|
|
TIBIAL INSERT PFC SZ 6 15.0MM
|
Facility
|
OP
|
$7,081.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.59 |
| Max. Negotiated Rate |
$6,798.19 |
| Rate for Payer: Aetna Commercial |
$5,452.72
|
| Rate for Payer: Anthem Medicaid |
$2,435.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,523.53
|
| Rate for Payer: Cash Price |
$3,540.72
|
| Rate for Payer: Cigna Commercial |
$5,877.60
|
| Rate for Payer: First Health Commercial |
$6,727.38
|
| Rate for Payer: Humana Commercial |
$6,019.23
|
| Rate for Payer: Humana KY Medicaid |
$2,435.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,460.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,806.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,226.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,124.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,484.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,231.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,311.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$920.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,195.25
|
| Rate for Payer: PHCS Commercial |
$6,798.19
|
| Rate for Payer: United Healthcare All Payer |
$6,231.68
|
|
|
TIBIAL INSERT PFC SZ 6 15.0MM
|
Facility
|
IP
|
$7,081.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.59 |
| Max. Negotiated Rate |
$6,798.19 |
| Rate for Payer: Aetna Commercial |
$5,452.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,523.53
|
| Rate for Payer: Cash Price |
$3,540.72
|
| Rate for Payer: Cigna Commercial |
$5,877.60
|
| Rate for Payer: First Health Commercial |
$6,727.38
|
| Rate for Payer: Humana Commercial |
$6,019.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,806.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,226.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,124.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,231.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,311.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$920.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,195.25
|
| Rate for Payer: PHCS Commercial |
$6,798.19
|
| Rate for Payer: United Healthcare All Payer |
$6,231.68
|
|
|
TIBIAL INSERT PFC SZ 6 17.5MM
|
Facility
|
IP
|
$7,081.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.59 |
| Max. Negotiated Rate |
$6,798.19 |
| Rate for Payer: Aetna Commercial |
$5,452.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,523.53
|
| Rate for Payer: Cash Price |
$3,540.72
|
| Rate for Payer: Cigna Commercial |
$5,877.60
|
| Rate for Payer: First Health Commercial |
$6,727.38
|
| Rate for Payer: Humana Commercial |
$6,019.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,806.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,226.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,124.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,231.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,311.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$920.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,195.25
|
| Rate for Payer: PHCS Commercial |
$6,798.19
|
| Rate for Payer: United Healthcare All Payer |
$6,231.68
|
|
|
TIBIAL INSERT PFC SZ 6 17.5MM
|
Facility
|
OP
|
$7,081.45
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$920.59 |
| Max. Negotiated Rate |
$6,798.19 |
| Rate for Payer: Aetna Commercial |
$5,452.72
|
| Rate for Payer: Anthem Medicaid |
$2,435.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,523.53
|
| Rate for Payer: Cash Price |
$3,540.72
|
| Rate for Payer: Cigna Commercial |
$5,877.60
|
| Rate for Payer: First Health Commercial |
$6,727.38
|
| Rate for Payer: Humana Commercial |
$6,019.23
|
| Rate for Payer: Humana KY Medicaid |
$2,435.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,460.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,806.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,226.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,124.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,484.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,231.68
|
| Rate for Payer: Ohio Health Group HMO |
$5,311.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$920.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,195.25
|
| Rate for Payer: PHCS Commercial |
$6,798.19
|
| Rate for Payer: United Healthcare All Payer |
$6,231.68
|
|
|
TIBIAL INSERT ROT TC3 SZ 1.5 1
|
Facility
|
OP
|
$23,980.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,117.50 |
| Max. Negotiated Rate |
$23,021.52 |
| Rate for Payer: Aetna Commercial |
$18,465.18
|
| Rate for Payer: Anthem Medicaid |
$8,246.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,704.98
|
| Rate for Payer: Cash Price |
$11,990.38
|
| Rate for Payer: Cigna Commercial |
$19,904.02
|
| Rate for Payer: First Health Commercial |
$22,781.71
|
| Rate for Payer: Humana Commercial |
$20,383.64
|
| Rate for Payer: Humana KY Medicaid |
$8,246.98
|
| Rate for Payer: Kentucky WC Medicaid |
$8,330.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,664.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,697.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,194.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,412.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,103.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,985.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,796.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,117.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,434.03
|
| Rate for Payer: PHCS Commercial |
$23,021.52
|
| Rate for Payer: United Healthcare All Payer |
$21,103.06
|
|
|
TIBIAL INSERT ROT TC3 SZ 1.5 1
|
Facility
|
IP
|
$23,980.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,117.50 |
| Max. Negotiated Rate |
$23,021.52 |
| Rate for Payer: Aetna Commercial |
$18,465.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$18,704.98
|
| Rate for Payer: Cash Price |
$11,990.38
|
| Rate for Payer: Cigna Commercial |
$19,904.02
|
| Rate for Payer: First Health Commercial |
$22,781.71
|
| Rate for Payer: Humana Commercial |
$20,383.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$19,664.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$17,697.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,194.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,103.06
|
| Rate for Payer: Ohio Health Group HMO |
$17,985.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,796.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,117.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,434.03
|
| Rate for Payer: PHCS Commercial |
$23,021.52
|
| Rate for Payer: United Healthcare All Payer |
$21,103.06
|
|
